Provincial Health Insurance

You receive basic health care through your provincial plan within Canada. The costs of standard hospital ward accommodation, Medical Doctors’ fees and some other services are covered by your provincial plan.

Extended Health Care coverage provided by the Writers' Coalition Program is intended to supplement, not replace, your provincial plan.

When you are Traveling or Residing Temporarily Outside your Province of Residence

AFBS does not provide emergency hospital or medical coverage, including Medical Doctors’ fees, for insured members who are traveling or residing temporarily outside their province of residence. However, Industrial Alliance Insurance and Financial Services Inc. provides a group policy for Travel Emergency Medical (TEM) to insured members of the Plan. Please ensure that this coverage is appropriate emergency hospital and medical coverage for you and your family if you plan to be outside of your province of residence. Should alternative protection be required you can consider Ingle International which can be found here. Note: Your group policy with Industrial Alliance cannot be used as an extension, or be extended by any other policy or private hospitalization plan. The group policy is null and void if you schedule or extend a trip beyond a 60 day duration.

Where coverage is available through the Province, the AFBS Program is secondary to any coverage/assistance provided by the Province as appropriate. Supporting documentation may be required.

“Eligible” expenses must be considered medically necessary for the treatment of an illness or injury and recommended by a Medical Doctor.

Extended Health Care (including Vision/Paramedical Care)

Standard

Comprehensive

All Years

Year One

Year Two

Subsequent Years

Reimbursement Percentage for each Insured Person

70%

70%

70%

70%

Annual Maximum for each Insured Person

$5,000*

$7,500*

$7,500*

$7,500*

Annual Maximum for each Insured Person for Vision/Paramedical Care

$350

$500

$500

$750

*Maximum includes benefits paid for Vision/Paramedical Care

Your Writers' Coalition Program covers the following medical supplies and services:

Accidental Dental

Standard

Comprehensive

Reimbursement

70% reimbursement per claim

70% reimbursement per claim

Important Information about this benefit

This is a covered Extended Health Care expense.

Details of the accident which are sufficient for AFBS to determine eligibility must be provided before any payment can be made under this benefit. Details could include pictures and/or witness statements outlining the nature of the accident, police reports, copies of hospital emergency records and/or information from the medical doctor or dentist who attended to the emergency.

Reimbursement is based on the current dental fee guide of the province in which services are provided or the usual and customary cost in those provinces where a fee guide is not issued.

There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year.

Air Ambulance to Hospital

Standard

Comprehensive

Reimbursement

70% reimbursement per claim up to a maximum of $4,000

70% reimbursement per claim up to a maximum of $4,000

Important Information about this benefit

This is a covered Extended Health Care expense.

Costs are limited to any amount that is not covered by your provincial health care plan for flights originating and terminating in your province of residence.

This benefit is not available for repatriation when an accident or illness occurs while travelling outside your province of residence.

This benefit is not available outside of Canada.

There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year

Artificial Eyes and Limbs*

Standard

Comprehensive

Reimbursement

70% reimbursement per claim up to a maximum of $5,000 every five Benefit Years, or every three years of continuous coverage for a dependent child under 18 years of age

70% reimbursement per claim up to a maximum of $5,000 every five Benefit Years, or every three years of continuous coverage for a dependent child under 18 years of age

Important Information about this benefit

This is a covered Extended Health Care expense.

*Requires an initial written confirmation from your medical doctor concerning the loss and which includes and clearly shows the doctor’s name, address and phone number.

Includes repair and replacement.

Includes myoelectric prosthesis.

There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year

Assistive Devices, Mobility aids and Medical Equipment

Standard

Comprehensive

Reimbursement

Abdominal, back or knee brace*

70% reimbursement per claim up to $500/knee Lifetime maximum and $500 for each of an abdominal or back brace Lifetime maximum*(3)

70% reimbursement per claim up to $500/knee Lifetime maximum and $500 for each of an abdominal or back brace Lifetime maximum*(3)

Reimbursement is based on the usual and customary cost of these items as determined by AFBS and is subsequent to any provincial plan coverage that may be available.

Limited to only those items specified above under Assistive Devices, Mobility aids and Medical Equipment;

* Requires a written recommendation from your medical doctor or nurse practitioner which includes the medical condition for which you are being treated and clearly shows the doctor/nurse practitioner’s name, address and phone number.(1)Receipts issued by a hospital will be accepted without the usual recommendation. (2)An initial medical recommendation may be required.

(5)Must be prescribed by one of: Medical Doctor (MD), Podiatrist (DPM), Chiropodist (d CH or D Pod M). Further, the product must be dispensed by one of the following providers and include the biomechanical assessment as well as an itemized receipt listing all the items and modifications. Recognized providers are: Orthotist (CO or CPO(c )), Pedorthist (C Ped(c) or C Ped (MC)), Podiatrist (DPM), Chiropodist (D CH od D Pod M).

Both the name and qualifications of the prescribing specialist and provider must be clearly noted.

There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year

Audiologist or Speech Therapist*

Standard

Comprehensive

Reimbursement

70% reimbursement per claim up to a maximum of $25 each visit†

70% reimbursement per claim for services provided up to a Benefit Year combined maximum (both practitioners) of $750

Important Information about this benefit

This is a covered Extended Health Care expense.

Reimbursement requires either a pathological or audiological impediment.

*Requires a written recommendation from your medical doctor each Benefit Year which includes the medical condition for which you are being treated and clearly shows the doctor’s name, address and phone number.

There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year

Emergency Ground Ambulance to Hospital

Standard

Comprehensive

Reimbursement

70% reimbursement per claim

70% reimbursement per claim

Important Information about this benefit

This is a covered Extended Health Care expense.

Reimbursement is based on any co-payment amount required by your province of residence.

Scheduled use of ambulance services is excluded.

This benefit is not available outside of Canada.

There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year

Fertility Testing*

Standard

Comprehensive

Reimbursement

Not covered

70% reimbursement per claim up to a Lifetime maximum of $2,500

Important Information about this benefit

This is a covered Extended Health Care expense where specified.

*Requires a written recommendation from your medical doctor which indicates the examination and clearly shows the doctor’s name, address and phone number.

There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year

Hearing Aids*

Standard

Comprehensive

Reimbursement

70% reimbursement per claim up to $500/ear every four Benefit Years – adult or every two Benefit Years - child

70% reimbursement per claim up to $500/ear every four Benefit Years – adult or every two Benefit Years - child

Important Information about this benefit

This is a covered Extended Health Care expense.

Reimbursement is subsequent to any provincial plan coverage that may be available.

*Requires an initial written recommendation from your medical doctor which includes the medical condition for which you are being treated and clearly shows the doctor’s name, address and phone number.

There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year

Home Care following hospitalization*

Standard

Comprehensive

Reimbursement

Not covered

70% reimbursement up to $30/day to a maximum of 30 days

Important Information about this benefit

This is a covered Extended Health Care expense.

Provides reimbursement when medically necessary for on-going recovery following hospitalization.

*With each occurrence, requires a written recommendation from your medical doctor which includes the medical condition for which you are being treated and clearly shows the doctor’s name, address and phone number.

Services require pre-approval by AFBS.

The provider must be supervised by an organization recognized to provide home care and be a licensed practical nurse (LPN), registered nurse (RN), registered nursing assistant (RNA), Personal Service Worker (PSW), Victorian Order of Nurses (VON) or other health care provider as deemed appropriate by your Medical Doctor and AFBS.

Excludes reimbursement to family members or companions.

Reimbursement from AFBS is subsequent to any provincial plan coverage that may be available.

Must be preceded by surgery (excluding cosmetic surgery) requiring at least one night of hospitalization or three days acute care hospitalization or following physical rehabilitation in a medical facility designated to provide these services.

This benefit must be used with 90 days following discharge.

There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year

Hospital Bed*

Standard

Comprehensive

Reimbursement

70% reimbursement per claim, combined with Medical Equipment and Assistive Devices up to a maximum of $2,500 each Benefit Year. Lifetime maximum $1,500

70% reimbursement per claim up to a Lifetime maximum $1,500

Important Information about this benefit

This is a covered Extended Health Care expense.

*With each submission, requires a written recommendation from your medical doctor which includes the medical condition for which the medical equipment is required and clearly shows the doctor’s name, address and phone number.

Reimbursement can be applied towards either rental or purchase costs.

Reimbursement is based on the usual and customary cost of the equipment as determined by AFBS;

There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year

70% reimbursement per claim for the first 5 days, 100% thereafter, semi-private only, no per day max

Important Information about this benefit

This is a covered Extended Health Care expense where specified.

Reimbursement is limited to the difference between standard ward accommodation and the covered daily room cost rate when an accredited hospital is providing acute care.

When an accredited hospital provides physical rehabilitation services immediately following acute care of at least three days, room costs as indicated above will also be eligible for reimbursement.

The cost of additional amenities or services for which the hospital may charge are excluded.

Room costs incurred in any of a convalescent, long term care, nursing home or a facility that primarily provides treatment for addiction(s) are NOT COVERED.

This benefit is not available outside of Canada.

There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year

Naturopathic or Homeopathic doctor

Standard

Comprehensive

Reimbursement

70% reimbursement per claim up to a maximum of $25 each visit†

70% reimbursement per claim up to a maximum of $45 each visit‡

Important Information about this benefit

This is a covered Extended Health Care expense.

With respect to the services of a naturopathic doctor, the practitioner must be a member in good-standing and registered/licensed by the provincial College of Naturopaths when practicing in BC, AB. SK. MB. ON and NS. In all other provinces the Naturopath must have completed at least 4,200 hours of training, be qualified within their province of practice to use the designation Naturopathic Doctor or N.D and be a member in good-standing of the Canadian Association of Naturopathic Doctors (CAND) or other such body that incorporates a code of ethics, disciplinary review and continuing education.

With respect to a homeopathic doctor, the practitioner must be a member in good-standing of the Canadian Society of Homeopaths.

Reimbursement is based on the usual and customary cost of this service as determined by AFBS.

Reimbursement of remedies, vitamins, supplements, supplies or other peripheral services are excluded.

There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year

Orthotics

Standard

Comprehensive

Reimbursement

Not covered

70% reimbursement per claim up to a Benefit Year maximum of $150

Important Information about this benefit

This is a covered Extended Health Care expense where specified.

Orthotics must be prescribed by one of: Medical Doctor (MD), Podiatrist (DPM), Chiropodist (d CH or D Pod M). Further, the product must be dispensed by one of the following providers and include the biomechanical assessment as well as an itemized receipt listing all the items and modifications. Recognized providers are: Orthotist (CO or CPO(c )), Pedorthist (C Ped(c) or C Ped (MC)), Podiatrist (DPM), Chiropodist (D CH od D Pod M).

Both the name and qualifications of the prescribing specialist and provider must be clearly noted.

There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year

Oxygen Set*

Standard

Comprehensive

Reimbursement

70% reimbursement per claim, combined with medical equipment and assistive devices up to a maximum of $2,500 each benefit Year

70% reimbursement per claim

Important Information about this benefit

This is a covered Extended Health Care expense.

*Requires an initial written recommendation from your medical doctor which includes the medical condition for which the medical equipment is required and clearly shows the doctor’s name, address and phone number.

There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year

Physiotherapist*

Standard

Comprehensive

Reimbursement

70% reimbursement per claim up to a maximum of $25 each visit†

70% reimbursement per claim up to a Benefit Year maximum of $750‡

Important Information about this benefit

This is a covered Extended Health Care expense.

*Requires a written recommendation from your medical doctor, each Benefit Year, which includes the medical condition for which you are being treated and clearly shows the doctor’s name, address and phone number.

Services must be provided within the scope of the practitioner’s license/designation for which a receipt for reimbursement is being submitted.

Reimbursement is based on the usual and customary cost of this service as determined by AFBS.

There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year

Private Duty Nursing following hospitalization*

Standard

Comprehensive

Reimbursement

70% reimbursement per claim, combined with medical equipment and assistive devices up to a maximum of $2,500 each Benefit Year

70% reimbursement per claim, up to a maximum of $2,500 each Benefit Year

Important Information about this benefit

This is a covered Extended Health Care expense.

Provides reimbursement when medically necessary for on-going recovery or when required for in-home palliative end-of-life support◊.

*With each occurrence, requires a written recommendation from your medical doctor which includes the medical condition for which you are being treated and clearly shows the doctor’s name, address and phone number.

Reimbursement from AFBS is subsequent to any provincial plan coverage that may be available.

Services must be put in place immediately following hospital discharge and may be extended over a period not exceeding 45 days.

Excludes reimbursement to family members or companions.

Excludes support required as a result of cosmetic surgery or procedures.

This is not a long-term care benefit.

There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year

◊Palliative support is payable during one occasion only. The three year and annual maximums will apply, however, the hospitalization and 45-day maximum requirements may be waived by AFBS.

Registered Dietician*

Standard

Comprehensive

Reimbursement

70% reimbursement per claim up to a maximum of $25 each visit†

70% reimbursement per claim up to a maximum of $45 each visit‡

Important Information about this benefit

This is a covered Extended Health Care expense where specified.

Reimbursement of remedies, vitamins, supplements, supplies, tests and other peripheral services are excluded.

*Requires a written recommendation from your medical doctor, each Benefit Year, which includes the medical condition for which you are being treated and clearly shows the doctor's name, address, and phone number.

There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year

Registered/Licensed Psychologist

Standard

Comprehensive

Reimbursement

70% reimbursement per claim up to a maximum of $25 each visit*

70% reimbursement per claim up to a maximum of $45 each visit**

Important Information about this benefit

This is a covered Extended Health Care expense.

The practitioner must be registered/licensed by the provincial College of Psychologists in which (s)he provides counselling services. PLEASE NOTE: Counselling services are also provided through the Member and Family Assistance Program (MFAP).

Reimbursement is based on the usual and customary cost of this service as determined by AFBS.

There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year

Registered Massage Therapist, Registered Acupuncturist*

Standard

Comprehensive

Reimbursement

70% reimbursement per claim up to a maximum of $25 each visit†

70% reimbursement per claim up to a maximum of $45 each visit‡

Important Information about this benefit

This is a covered Extended Health Care expense.

*SPECIAL NOTE: With respect to massage therapy and acupuncture, a written recommendation is required from your medical doctor every Benefit Year which includes the medical condition for which you are being treated and clearly shows the doctor’s name, address and phone number.

Services must be provided within the scope of the practitioner’s license/designation for which a receipt for reimbursement is being submitted.

Reimbursement is based on the usual and customary cost of this service as determined by AFBS.

There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year

Special vision care benefit after cataract surgery

Standard

Comprehensive

Reimbursement

Not covered

Lifetime maximum of $500/eye

Important Information about this benefit

This is a covered Extended Health Care expense.

Requires medical confirmation of the date of cataract surgery from your treating medical doctor including and clearly showing the doctor’s name, address and phone number.

Receipts must be submitted for any of a corrective lens, contact lens or prosthetic lens required as a result of the cataract surgery and which are not covered by your provincial health plan.

Any laser vision surgery follow-up is excluded.

Medical doctor or medical office fees are excluded.

This benefit is payable in addition to any vision care benefits payable.

There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year

Vision Care

Standard

Comprehensive

Reimbursement

70% reimbursement up to $150 every two Benefit Years, combined with paramedical services up to $350 every benefit year

70% reimbursement per claim up to $325 every two Benefit Years, combined with paramedical services up to $500 every benefit year for years 1 and 2 and $750 in subsequent years

Important Information about this benefit

This is a covered Extended Health Care expense.

Reimbursement is limited to eye examinations provided by an Optometrist or Ophthalmologist, laser eye surgery and the purchase of prescription glasses (excluding sunglasses or safety glasses) or contact lenses.

There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year

Wheelchair*

Standard

Comprehensive

Reimbursement

70% reimbursement per claim, combined with Medical Equipment and Assistive Devices up to a maximum of $2,500 each Benefit Year. Lifetime maximum $1,000

70% reimbursement per claim up to a Lifetime maximum $1,000

Important Information about this benefit

This is a covered Extended Health Care expense.

*With each submission, requires a written recommendation from your medical doctor which includes the medical condition for which the medical equipment is required and clearly shows the doctor’s name, address and phone number.

Reimbursement can be applied towards either rental or purchase costs.

Reimbursement is based on the usual and customary cost of the equipment as determined by AFBS;

There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year

Wigs*

Standard

Comprehensive

Reimbursement

70% reimbursement per claim up to a lifetime maximum of $1,000, only for cancer patients undergoing treatment

70% reimbursement per claim up to a lifetime maximum of $1,000, only for cancer patients undergoing treatment

Important Information about this benefit

This is a covered Extended Health Care expense.

*With each submission, requires a written recommendation from your medical doctor which includes the medical condition for which you are being treated and clearly shows the doctor’s name, address and phone number.

There is a cumulative annual reimbursement maximum of $5,000 for the Standard Plan and $7,500 for the Comprehensive Plan on all extended health care claims paid each Benefit Year

Not Eligible Extended HealthCare Expenses

Services and supplies which are not specifically listed as a covered expense are not eligible for reimbursement through the Writers' Coalition Program. The following are also ineligible for reimbursement:

Payment of the provincial health care premium.

Services payable through any provincial hospital plan or provincial health care plan, WSIB/Workers’ Compensation, other government agencies, other insurers or other sources.